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<body>
	<fieldset class="dispensation">
		<legend><wicket:message key="dispensation.pdf.person.title">[dispensation.pdf.person.title]</wicket:message></legend>
		<table class='dataview' width="100%">
			<tr>
				<th bgcolor="#C1E4FF"><label><wicket:message key="person.fullname">[person.fullname]</wicket:message></label></th>
				<th bgcolor="#C1E4FF"><label><wicket:message key="person.id">[person.id]</wicket:message></label></th>
				<th bgcolor="#C1E4FF"><label><wicket:message key="person.birthdate">[person.birthdate]</wicket:message></label></th>
				<th bgcolor="#C1E4FF"><label><wicket:message key="person.country">[person.country]</wicket:message></label></th>
				<th bgcolor="#C1E4FF"><label><wicket:message key="person.gender">[person.gender]</wicket:message></label></th>
			</tr>
			<tr>
				<td><span wicket:id="fullname">Lars Larsson</span></td>
				<td><span wicket:id="id">123412121234</span></td>
				<td><span wicket:id="birthdate">12341212</span></td>
				<td><span wicket:id="country">Sweden</span></td>
				<td><span wicket:id="gender">Male</span></td>
			</tr>
		</table>
	</fieldset>
	
		<fieldset class="dispensation">
		<legend><wicket:message key="dispensation.pdf.prescription.title2">[dispensation.pdf.prescription.title2]</wicket:message></legend>
    <table wicket:id="dispenseRows" class="dataview" width="100%">
    	<tr>
            <th class="dark" bgcolor="#9FBFDF" colspan='5' style="padding-left: 5px;">
            	<label class="special2"><wicket:message key="dispensation.pdf.dispensation.title">[dispensation.pdf.dispensation.title]</wicket:message></label>
            </th>
        </tr>
        <tr>
			<th bgcolor="#C1E4FF" colspan='2'><label><wicket:message key="prescription.productName">[prescription.productName]</wicket:message></label></th>
			<th bgcolor="#C1E4FF"><label><wicket:message key="prescription.productId">[prescription.productId]</wicket:message></label></th>
			<th bgcolor="#C1E4FF"><label><wicket:message key="prescription.quantity">[prescription.quantity]</wicket:message></label></th>
			<th bgcolor="#C1E4FF"><label><wicket:message key="prescription.nbrOfPackages">[prescription.nbrOfPackages]</wicket:message></label></th>
		</tr>
		<tr>
			<td colspan='2'><span wicket:id="productName">Bricanyl Turbuhaler</span></td>
			<td><span wicket:id="productId">012343</span></td>
			<td><span wicket:id="packageSize.quantityValue">100</span>&nbsp;<span wicket:id="packageSize.quantityUnit">st</span></td>
			<td><span wicket:id="nbrPackages.quantityValue">100</span>&nbsp;<span wicket:id="nbrPackages.quantityUnit">st</span></td>
		</tr>
		<tr>
            <td colspan='5'>&nbsp;</td>
        </tr>
        <tr>
            <th colspan='5' class="dark" style="padding-left: 5px;">
                <label class="special2">
                	<wicket:message key="dispensation.pdf.prescription.title">[dispensation.pdf.prescription.title]</wicket:message><br/>
                    <span wicket:id="prescriptionRow.description">
                        terbutaline 0.5 [mg]/1[dos] 200 [] Inhalation powder (Bricanyl® Turbuhaler®)
                    </span>
                </label>
            </th>
        </tr>
        <tr>
		    <th bgcolor="#C1E4FF" colspan="2"><label><wicket:message key="prescription.productName">Product Name</wicket:message></label></th>
		    <th bgcolor="#C1E4FF"><label><wicket:message key="prescription.productId">Product Id</wicket:message></label></th>
		    <th bgcolor="#C1E4FF"><label><wicket:message key="prescription.prescriptionid">Prescription Id</wicket:message></label></th>
		    <th bgcolor="#C1E4FF"><label><wicket:message key="prescription.substitutionPermitted">Substitution allowed?</wicket:message></label></th>
		</tr>
		<tr>
		    <td colspan="2"><span wicket:id="prescriptionRow.productName">Bricanyl Turbuhaler</span></td>
		    <td><span wicket:id="prescriptionRow.productId">012343</span></td>
		    <td><span wicket:id="prescriptionRow.prescriptionId">123.1.2</span></td>
		    <td><span wicket:id="prescriptionRow.substitutionPermitted">Yes</span></td>
		</tr>
		<tr>
			<th bgcolor="#C1E4FF" colspan="5"><label><wicket:message key="prescription.ingredient">[prescription.ingredient]</wicket:message></label></th>
		</tr> 
		<tr>
			<td colspan="5"><table width="100%" class="dataview">
		  <tr>
		      <th bgcolor="#CCCCCC" colspan="2"><label><wicket:message key="prescription.activeIngredient">Active Ingredient</wicket:message></label></th>
		      <th bgcolor="#CCCCCC" width="30%"><label><wicket:message key="prescription.strength">Strength</wicket:message></label></th>
		  </tr> 
				<tr wicket:id="ingredientRow">
					<td colspan="2"><span wicket:id="activeIngredient">Diklofenakk</span></td>
		    		<td width="30%"><span wicket:id="strength">50mg</span></td>
		    	</tr>
			</table></td>
		</tr>
		<tr>
			<th bgcolor="#C1E4FF" colspan="2"><label><wicket:message key="prescription.form">Dose form</wicket:message></label></th>
		    <th bgcolor="#C1E4FF"><label><wicket:message key="prescription.typeOfPackage">Type Of Package</wicket:message></label></th>
		    <th bgcolor="#C1E4FF"><label><wicket:message key="prescription.quantity">Package size</wicket:message></label></th>
		    <th bgcolor="#C1E4FF"><label><wicket:message key="prescription.nbrOfPackages">Number Of Packages</wicket:message></label></th>
		</tr> 
		<tr>
			<td colspan="2"><span wicket:id="prescriptionRow.formName">Tablett</span></td>
		    <td><span wicket:id="prescriptionRow.typeOfPackage"></span></td>
		    <td><span wicket:id="prescriptionRow.packageSize.quantityValue">100</span> <span wicket:id="prescriptionRow.packageSize.quantityUnit">st</span></td>
		    <td><span wicket:id="prescriptionRow.nbrPackages.quantityValue">2</span> <span wicket:id="prescriptionRow.nbrPackages.quantityUnit">st</span></td>
		</tr>
		<tr>
		    <th bgcolor="#C1E4FF"><label><wicket:message key="prescription.min">Onset date</wicket:message></label></th>
		    <th bgcolor="#C1E4FF"><label><wicket:message key="prescription.max">End date</wicket:message></label></th>        
		    <th bgcolor="#C1E4FF"><label><wicket:message key="prescription.frequency">Frequency</wicket:message></label></th>
		    <th bgcolor="#C1E4FF"><label><wicket:message key="prescription.dosage">Dosage</wicket:message></label></th>
		    <th bgcolor="#C1E4FF"><label><wicket:message key="prescription.route">Route of administration</wicket:message></label></th>
		</tr>
		<tr>
		    <td><span wicket:id="prescriptionRow.startDate">2011-08-23</span></td>
		    <td><span wicket:id="prescriptionRow.endDate">2012-04-13</span></td>
		    <td><span wicket:id="prescriptionRow.frequency">daily</span></td>
		    <td><span wicket:id="prescriptionRow.dosage">2</span></td>
		    <td><span wicket:id="prescriptionRow.route">Oral</span></td>
		</tr>
		<tr>
		    <th bgcolor="#C1E4FF" colspan="5"><label><wicket:message key="prescription.patientInstructions">Instructions to patient</wicket:message></label></th>
		</tr>
		<tr>
		    <td colspan="5"><span wicket:id="prescriptionRow.patientInstructions">Some patient instruction...</span>&nbsp;</td>
		</tr>
		<tr>
		    <th bgcolor="#C1E4FF" colspan="5"><label><wicket:message key="prescription.pharmacistInstructions">Instructions to pharmacist</wicket:message></label></th>
		</tr>
		<tr>
		    <td colspan="5"><span wicket:id="prescriptionRow.pharmacistInstructions">Some pharmacist instruction...</span>&nbsp;</td>
		</tr>
	</table>   
	</fieldset>
	
	<fieldset>
		<legend><wicket:message key="dispensation.pdf.pharmacist.title">[dispensation.pdf.pharmacist.title]</wicket:message></legend>
		<table class="dataview" width="100%">
			<tr>
				<th bgcolor="#C1E4FF"><label><wicket:message key="userdetails.commonname">[userdetails.commonname]</wicket:message></label></th>
				<th bgcolor="#C1E4FF"><label><wicket:message key="userdetails.organisationname">[userdetails.organisationname]</wicket:message></label></th>
				<th bgcolor="#C1E4FF" colspan="2"><label><wicket:message key="userdetails.organisationid">[userdetails.organisationid]</wicket:message></label></th>
			</tr>
			<tr>
				<td><span wicket:id="commonName">Sven Svensson</span></td>
				<td><span wicket:id="organizationName">Svea</span></td>
				<td colspan="2"><span wicket:id="organizationId">1234</span></td>
			</tr>
			<tr>
				<th bgcolor="#C1E4FF"><label><wicket:message key="userdetails.telecom">[userdetails.telecom]</wicket:message></label></th>
				<th bgcolor="#C1E4FF"><label><wicket:message key="userdetails.streetaddress">[userdetails.streetaddress]</wicket:message></label></th>
				<th bgcolor="#C1E4FF"><label><wicket:message key="userdetails.city">[userdetails.city]</wicket:message></label></th>
				<th bgcolor="#C1E4FF"><label><wicket:message key="userdetails.postalcode">[userdetails.postalcode]</wicket:message></label></th>
			</tr>
			<tr>
				<td><span wicket:id="telecom">+461234</span></td>
				<td><span wicket:id="streetaddress">Ringvägen 10</span></td>
				<td><span wicket:id="city">Stockholm</span></td>
				<td><span wicket:id="postalCode">12345</span></td>
			</tr>
		</table>
	</fieldset>
</body>
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